Cardiac Palpitation of Gastric Origin. EDITOR MEDICAL WORLD:-I recently had a case of cardiac palpitation of gastric origin in a young woman, five months pregnant, nullipara, which lasted from 10 o'clock at night until 7 the next morning, the average pulse rate being 215 per minute. The case resisted ordinary remedies, even morphin, until after a large dose of soda bicarbonate, of which she had already had a considerable quantity, the rhythm suddenly adjusted itself, and the attack was over.

I have not been able to go very deeply into the literature of these disturbances, but neither I, nor anyone with whom I have discust the case, have seen an attack persisting that long. Altho emetics are, as a general thing, not indorsed in the treatment of these conditions, on account of the danger of seriously depressing the heart, yet I felt justified in provoking emesis by the use of mustard, but with disappointing results.

I believe this case is unique from the length of the attack. I have seen it persist for several hours in a robust young man, and have seen several attacks in the course of one day occurring in a woman with poor compensation; but for it to last nine hours when due, as far as could be determined, to gastric irritability, is out of the ordinary. Marysville, Wash. J. D. THOMPSON.

Answers to Queries.

EDITOR MEDICAL WORLD:-I have been a subscriber of THE WORLD for some time, and enjoy your journal very much; in fact, don't see how I could get along without it now.

Locomotor Ataxia.

Anent a few articles in the February issue, I would like to say a few words: First, as to Dr. M. L. Dalton's query of Dr. Burton's locomotor ataxia treatment (page 78), will say I have his literature and don't see why most any of "the family" can't do nearly as well as he claims. According to my limited experience and that of some of my acquaintances I believe mercury salicylate hypodermically to give nearly, if not quite, as good results as he claims, and I would not hesitate to guess this to be his treatment; that is, if he gets as good results as he claims.

Home Treatment of Narcotism.

The Towns treatment for narcotics given in answer to Dr. J. C. O'Dwyer's query (page 74) is all right for hospital use, as your editorial states, but this is not of much benefit to the general practician. I have modified the treatment by adding glycerin and simple elixir to the belladonnaxanthoxylin-hyoscyamus mixture and also adding avena sativa, passion flower, Jamaica dogwood and compound tincture of cinchona and gradually reducing the morphin in the mixture, thus making a home treatment out of same with the very best of success. There is no use for it to be further declared that this condition cannot be cured in the home, as an authority on same wrote me since I have been so treating it with the very best of

The company employing him sent my bill to the Royal Indemnity Co., 84 William Street, New York, from whom today I receive a letter requesting me "to amend it (bill) in regard to the two-dollar charge for office visit." They further state that they "enclose schedule of medical fees generally accepted by the Compensation Commission for "You medical attention in compensation cases." will note that one dollar is the amount allowed for each office call." The fee schedule inclosed is printed, "Approved by Medical Society of State of New York, by Alexander Lambert, M.D., Chairman Workman's Compensation Committee, for the Committee. Approved by the New York Claim Association, by W. L. Gahagan and Geo. C. Taft."

I am inclosing herewith the schedule, and you may note with joy for yourself some of the generous fees mentioned. In the case of the patient I treated, the actual work took over 25 minutes each time, to say nothing of sterilization of instruments, material for surgical dressings, and time and care while hand was soakt in antiseptic solution, nearly an hour in all.

returning bill

My reply to them: respectfully declining to comply with your request, as the fee is a fair one and will stand. My lowest fee for office work is $1, and this for an ordinary medical call without extra work or medicins. Mr. S.'s wound required nearly an hour to dress, and the charge is not exorbitant. The Compensation Committee you mention has no jurisdiction over my fees, nor am I a member of the Medical Society of the State of New York. If both are willing to stand for cheapened work, they can, but I don't. My bill is against the Upany, and I should prefer your corresponding thru them in order that they may know what a cheapskate company they are insuring with."

·Com

Further details when they occur, but I wanted to get this to you early, so that you may take the matter up in THE WORLD at once. One would think we are to work at a reduced fee because the companies favor us by permitting their workmen to be injured.

It is to laugh or is it? RALSTON REED, M.D. Morristown, N. J.

[The following is the schedule.—ED.]

MEDICAL AND SURGICAL FEE BILL.

Schedule of Rates.

SPECIFIC INJURIES.

A

B

D

105

Cases not specifically included in this schedule are to be treated on basis of day and night visits, except where special treatment is necessary. In that event, the facts (if not an emergency case) are to be submitted to the insurance carrier and arrangements made with it for such additional or special treatment.

Treatments shall not exceed sixty days (as provided by the law, section 13) from date of injury, except upon special arrangement with insurance carrier.

These fees have been established with the understanding that they include, in all cases, ordinary dressings and anesthetics, etc., for the proper treatment of each case, and that they will be supplied by the attending physician. It is also understood that the strictest aseptic precautions will be observed in accordance with approved methods of surgery.

It is understood that itemized bills shall be rendered immediately after treatment ceases, or in any event, at the expiration of sixty days from date of injury. Such bills are to be itemized, showing date of each visit, dressing or operation, and charge for same.

Reports relativ to condition of injured employees under treatment shall be made when requested, without extra charge.

This Schedule, except as to general items, contains three systems, any one of which may be followed by the physician according to circumstances.

I. Column A shall apply when the same physician operates and also gives subsequent treatment.

II. Columns B and C when one physician operates and another gives subsequent treatment.

III. Columns B, C and D when one physician operates and another gives subsequent treatment. Charges for each visit to be on the basis of column D, total not to exceed column C.

Approved by Medical Society of the State of New York, by Alexander Lambert, M. D., Chairman Workmen's Compensation Committee, for the Committee.

Approved by New York Claim Association, by W. L. Gahagan and Geo. C. Taft.

[A synopsis of this schedule was printed in January WORLD, page 25. As stated there, it is a movement intended to put charges for the treatment of injured workmen on a collectible basis and is only operativ in New York State until July 1st, next. The fee bill of the physicians of Herkimer County, New York, is also printed in January WORLD, pages 23 to 25.-ED.]

Physical vs. Medical Methods of Treatment. Axiom "The whole is greater than any of its parts."

EDITOR MEDICAL WORLD:-Our topic might at first seem to suggest that there was a controversy or contest between what have been designated "physical" methods of treating diseases, as contrasted with the internal administration or external application of what have come to be known as "drugs" or "medicins."

Nothing could be farther from the truth, tho the advocates of various methods of treatment may divide themselves, or be divided, into hostil camps. As well discuss "boots vs. gloves," or "hats vs. coats." These are all parts of wearing apparel, all very desirable and useful, if not absolutely necessary; yet neither can perform the functions of the others. The preference for one or another all depends on your problem, on what you want to accomplish.

And results-just plain, everyday, unqualified and unanalyzed results-will not settle this imagined dispute. The proponents and enthusiastic practicians of every new healing cult will point to an array of unmistakable cures of undoubted actual disease, as proof of the correctness of their theory of disease, its cause and treatment. But they lose sight of or disregard the fact that practically every method of treating disease that has ever come across the horizon is fortified with identically the same evidence to sustain and maintain its claim for recognition.

Conversely, there is no method of treating disease that has not failed to cure the patient-allopathic drugging, homeopathic medication, eclectic dosing, osteopathic manipulation, chiropractic adjustment, electrotherapy, psychotherapy, hydrotherapy, spondylotherapy and every other therapy and method has, each of them, many cures to its credit, and plenty of failures-to the disgust of its devotees.

Why, then, these contradictory facts, at once so convincing and confusing? First of all, we may as well recognize the fact that here and there occur certain cases of certain diseases that are simply incurable by any known means. But largely this situation is due to the fact that the various practicians insist upon putting square remedies into round ailments-insist upon making the disease fit the treatment to which they are committed, rather than suiting the treatment to

the trouble to be corrected-have sought to make the ear-trumpet do the duty of the eyeglass.

The microscope reveals bacteria and the minute structure of matter, but the astronomer finds the telescope more useful in scanning the heavens; each is an invaluable optical aid to vision, but serviceable only in the particular field of investigation to which it is adapted-neither can supplant the other, nor can one be said to be superior to the other.

The incontrovertible fact that practically every method, system or school of healing has both cured and failed to cure positivly disproves the existence of any one cause of disease-the corollary of which is that there likewise cannot be any one effectiv method of healing for all cases of all diseases.

In the relief of suffering and the cure of disease I have successfully prescribed medicin, utilized electric energy, directed psychic forces, administered osteopathic manipulation, employed chiropractic adjustment, etc. Had I been chained to "medical" methods I should perhaps have drugged some unfortunate whose spine needed adjustment-and failed to cure; had I depended upon osteopathic treatment when there was some chemical discord in the bodily metabolism that required nutritiv or correctiv agents; or had I placed reliance upon the electric current to antagonize, antidote or neutralize circulating toxins in the body, my patient would have found his way to some other doctor-or to the undertaker.

No, "physical" methods are not versus "medical" methods. Whence, then, the supposed rivalry? First is the fact that for ages the only treatment known was medical; and we of to-day, possest, if not obsest, by the accumulating heritage of generations, find it hard to question Solomon's assumed finality that "there is nothing new under the sun"-tho we have no reason for presuming that wireless telephony, aviation and a few other commonplaces of to-day were familiar to that polygamous potentate. Physical methods of treating disease are new-some newer than others--and they are unquestionably, even tho limitedly, successful, when discriminatingly and skilfully employed in properly selected cases, and where indicated: but, like medical methods, they also fail when relied upon in unsuitable cases or when bunglingly administered.

Further, most of the "physical" methods of treatment that have been proposed or are now being propagated have been exploited in such absurdly and ridiculously extravagant fashion as to instantly discredit them with people of education, poise and judgment. In ludicrously mutilated English, the exponents of each new method have sought to garb and have championed their pet scheme as a panacea. Having become possest of, or rather by, a nondescript bug, they have set themselves up as entomologists of surpassing and superlativ knowledge. Insisting that the link which they have forged-granting its unquestioned value and extended utility-is the whole chain, all that has been previously learnt of the structure, functions and ailments of the human body is but junk to be thrown into the discard. And everybody who has treated, or now treats, any disease by any other than their one method must bear the label "idiot" or "knave" or both.

In the healing art, as in every other field of human activity, the key to success is in doing

the right thing in the correct manner at the psychologic moment. Bearing in mind the fact that the human body is an intricately complicated machine, and also a most wonderful chemical laboratory, is it not possible, yes probable, that among both "physicalists" and "medicalists" there are too many who are at once idolators and iconoclasts, to whom "our" method is always right, and the "other" invariably and necessarily wrong? JAY H. RADLEY, M.D.

112 West 71st St., New York City.

Osteopaths Not Recognized in Red Cross
Work.

EDITOR MEDICAL WORLD:-At the bottom of page 50, first column, in the February, 1915, MEDICAL WORLD, I note the statement regarding osteopaths and Christian scientists remaining at home during the war. This is certainly an unfair statement, and I feel that if you know the situation more fully you will realize why this is the case as regards osteopaths.

I organized a Red Cross Field Corps in Brooklyn, N. Y., a few years ago and spent a good deal of time and money attempting to prepare the members in army hospital corps drill and have them equipt and ready for service in war or emergencies. I was informed that even if I organized the detachments up to the strength of a column, that I could not have command as I had no "M.D." degree. I was informed that it was the degree and not the qualifications that counted.

An osteopath tried to gather medical and other supplies for relief work during the floods in Ohio about a year and a half ago. He found that the Red Cross organization refused to recognize him as a physician and would not accept his assistance, allowing the local medical physicians to get all the credit for the relief work.

Now, Doctor, if an osteopathic physician should offer his service as a physician and surgeon in the present war as other doctors have done, would he not be accepted as possibly an interne or even an orderly or litter bearer? I am certain that he could not be recognized as a surgeon, even tho surgery and hospital work are taught in the osteopathic colleges, and an examination in surgery is required of osteopathic applicants for examination in New York and some other states.

How do you know that some osteopathic physicians have not offered their services and had them refused again? I am certain that the obstacles which are usually thrown in the way of progress by many medical organizations when it comes to new methods of practise which are not "regular," would successfully deter the acceptance of osteopaths as physicians and surgeons for war service.

If it was selfishness, as your paper states, you would not find osteopathic free clinics in many cities and other charitable work of that kind carried on by the osteopathic profession. And, again, when attempts to establish these free clinics have been made, medical organizations have again many times retarded the work and then claimed that the osteopathic profession will not do charitable work.

Middletown, N. Y. JOSEPH FERGUSON, D.O.

EDITOR MEDICAL WORLD-Inclosed check for $6. Chalk me up for eight years, and oblige.

1311 S. 29th St., Omaha, Neb. F. H. FOWI ER.

Neuritis, Arthritis Deformans and Paralysis

Agitans.

EDITOR MEDICAL WORLD:-By request, I wish to offer some additional data upon the subject of neuritis, arthritis deformans and paralysis agitans. This refers to the letters on these subjects by Dr. Charles M. Collins, Dr. M. J. Carey, Dr. J. I. T. Long and Dr. H. F. Hudson, upon pages 27, 28 and 29 of the January, 1915, WORLD. Certainly in view of the newer medical electricity our treatment methods of the diseases mentioned have radically changed, and reference to recent authoritativ works and articles upon the subject will confirm this view.

I would refer you to my monograf entitled "Newer Methods in the Treatment of Neuritis," in the volume of "International Clinics" for December, 1913 (publisht by the J. B. Lippincott Company, Philadelphia), volume iv, 23d series.

In the Journal of Advanced Therapeutics for November, 1913, pages 432 et seq., will be found an article by the writer upon "Deforming Arthritis and Intestinal Stasis.'

For recent data upon paralysis agitans I would refer to the recent work upon you Ionic Medication," by Lewis Jones, publisht by P. Blakiston's Son & Co., 1012 Walnut St., Philadelphia, 1914. Also to Prof. Le Duc's address before the British Medical Association on "Ionization of the Brain" for its improved nutrition that will be found in the London Lancet for March 22, 1913.

22 S. 21st St., Philadelphia.

A. B. HIRSH, M.D.

Rheumatism, Not Neuritis.

EDITOR MEDICAL WORLD:-If Dr. Collins (pages 27 and 28, January WORLD) will call his case rheumatism he will agree with my experience with the same trouble. I had it two years ago so I could not lift my right hand to the top of my head, and have had it again this winter. As he says, salicylates do no good, but if he will take Lloyds' macrotys and their bryonia 5 or 6 minims of each four times a day, and follow it up, he may be benefited. It is all that has done any good for

me.

He has practised seventeen years; I have practised nearly forty-one, am 70 years old, never had a tooth extracted, none decayed, have not been sick in bed for forty-five years, do not use tobacco or liquors in any form, do not chew gum; know how to swear, but don't do it; eat anything anyone eats, but cheese; drink a small cup of coffee two or three times a day.

I may some day write a little of my experiences for the World. I. S. BOLES. Shellsburg, Iowa.

Warren, in American Journal Medical Sciences, calls attention to a source of confusion in diagnosis of tumors of the female breast. If the breast be pincht between the thumb and fingers, it doubles upon itself more or less, and a sensation is imparted as if a tumor is present when there is really no tumor. He advises that after removal of the clothing, the examiner stand behind the woman, and palpate the breast with rigid fingers. In this method of examination, the gland proper is readily distinguisht as an almost impalpable mass of very soft consistency, and any new growth is readily distinguisht by its bulk or hardness.

Pioneers in Surgery.

EDITOR MEDICAL WORLD:-Allow me to say, you are, so far as I am concerned, privileged to have your own opinion on politics, religion and the human slaughter house in civilized and Christianized Europe. Occasionally one of the brothers crawls in with a dogmatic pen dipt in the acid ink of skepticism-Dr. Reycraft, on page 57, February WORLD. I think we owe a great deal to the pioneers, e. g., Ephraim McDowell in abdominal surgery; S. D. Gross before his death was experimenting with intestinal surgery; Nicholas Senn was his pupil and assistant. Afterward Senn publisht a book on the subject. Gross is unknown to many of the younger men. Ben. Franklin was the beginner in electric work, and the present generation is reaping the benefit. Laennec was the daddy of the stethoscope. Wonder if in Dr. Reycraft's 1,000 laparotomies he met with ptosis of any abdominal organ. THOS. L. GETTLE. Paris, Va.

Ferrous carbonate, in powder or in ointment, is an excellent dressing for chronic ulcers, especially those of the leg, and even when syphilitic in origin. It is a good cicatrizant. The cavity is filled with the powder, and lint and bandage applied. When crusts form, they are removed by oil of sweet almonds, applied with a camel's hair brush. In stubborn and inveterate cases, one may rub the base of the ulcer with lunar caustic and then with a piece of metallic zinc shaved till the surface is bright; thus the acid nitrate of zinc is formed, and granulations stimulated, when it is then drest with the ferrous carbonate. The acid nitrate of zinc application is painful, but efficient.

The Carvers.

We used to call it gripes, when we had stomach trouble, and all our inward pipes would ache and bend us double. It was a common ill that caused no awe or wonder, and granny's simple skill full soon would knock it under. The poor men in their cots, the rich man in his castle, were often tied in knots, and with the gripes would wrastle. A dose of homemade dope would quell the dire upheaval, restoring faith and hope, displacing pain and evil. But now the doctor comeshis science sure a blight is!-he looks and haws and hums, and cries, "Appendicitis!" He promptly spoils your peace, and makes your courage mizzle, as from his old valise he takes a saw and chisel, a cleaver and some dirks, and how the patient hollers, when he removes one's works, and charges ninety dollars! The docs are done with pills, in this and other nations; no matter what your ills, they call for "operations." Lumbago in our backs, the jaundice and hay fever, demand the saw and axe, the hatchet and the cleaver. The druggist's trade is poor, and soon he will be starving; the doctor's only cure, these modern days, is carving.-WALT MASON, in Philadelphia Bulletin.

EDITOR MEDICAL WORLD-The best evidence of my appreciation of THE WORLD is the fact that I have paid my money for it for a long number of years while recognizing its value purely as a medical journal, I do not hesitate to say that the "Monthly Talks" are more than worth the money; while not always agreeing with the editor, the subjects make one think, and it is only by agitation will the social questions that are admittedly so much out of line with justice be rightly settled. L. C. CHENOWETH.

Webb City, Mo.